Natural History of Headache after Traumatic Brain Injury
Abstract
Headache is one of the most common persisting symptoms after traumatic brain injury (TBI). Yet there is a paucity of prospective longitudinal studies of the incidence and prevalence of headache in a sample with a range of injury severity. We sought to describe the natural history of headache in the first year after TBI, and to determine the roles of prior history of headache, sex, and severity of TBI as risk factors for post-traumatic headache. A cohort of 452 acute, consecutive patients admitted to inpatient rehabilitation services with TBI were enrolled during their inpatient rehabilitation from February 2008 to June 2009. Subjects were enrolled across 7 acute rehabilitation centers designated as TBI Model Systems centers. They were prospectively assessed by structured interviews prior to inpatient rehabilitation discharge, and at 3, 6, and 12 months after injury. Results of this natural history study suggest that 71% of participants reported headache during the first year after injury. The prevalence of headache remained high over the first year, with more than 41% of participants reporting headache at 3, 6, and 12 months post-injury. Persons with a pre-injury history of headache (p<0.001) and females (p<0.01) were significantly more likely to report headache. The incidence of headache had no relation to TBI severity (p=0.67). Overall, headache is common in the first year after TBI, independent of the severity of injury range examined in this study. Use of the International Classification of Headache Disorders criteria requiring onset of headache within 1 week of injury underestimates rates of post-traumatic headache. Better understanding of the natural history of headache including timing, type, and risk factors should aid in the design of treatment studies to prevent or reduce the chronicity of headache and its disruptive effects on quality of life.
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Copyright 2011, Mary Ann Liebert, Inc.
History
Published online: 15 September 2011
Published in print: September 2011
Published ahead of print: 29 August 2011
Published ahead of production: 6 July 2011
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Dr. Hoffman, Dr. Lucas, Dr. Dikman, Ms. Braden, Dr. Brown, Dr. Brunner, Dr. Diaz-Arrastia, Dr. Walker, Dr. Watanabe, and Dr. Bell receive research funding from the NIDRR. Dr. Lucas receives funding for other clinical research from Merck, MAP Pharmaceuticals, Inc., Nupathe, the National Headache Foundation, and the Wadsworth Foundation. She also received institutional support for lectures given to Merck, GlaxoSmithKline, and Zogenix. Dr. Dikmen receives research funding from the National Institute of Health (NIH) and the Department of Defense. Dr. Bell receives research funding the Department of Defense. She received payment for travel and lecture to attend the 3rd Croatian Congress on NeuroRehabilitation and Restoration Neurology and for the American Association for the Advancement of Science, Contemporary Forums. She has received funding for travel to attend the American Academy of Physical Medicine and Rehabilitation, INTRuST Clinical Consortium, Alaska Brain Injury Network, Third Trauma Spectrum Conference, Brooke Army Medical Center, and the Kaiser Foundation.
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